Organized Mammography Screening Program Research Articles

Differences in mammography screening attendance among non-Western immigrants in Denmark, Finland, Iceland and Norway

Several studies have shown that attendance rates are lower among non-Western immigrants than among natives. As the Nordic countries have quite similar health systems and populations but also differences in the organisation of their organised mammography screening programmes, differences in attendance rates could highlight organisational factors that might increase the attendance rates. Mammography screening is offered free of charge in Denmark and Finland, but not in Iceland and Norway. Contrarily to the other countries, Iceland do not send out pre-booked appointment.The study population included natives and non-Western immigrants aged 50–69 years, who had at least one invitation to the national mammography screening programmes in Denmark (2008–2017), Finland (2001–2017), Iceland (2001–2020) or Norway (2001–2015). Relative risks (RRs) of attendance were estimated and adjusted for age group and calendar period.The study population included 116.033 non-Western immigrants and more than 2 million natives. The attendance rates were significantly lower among non-Western immigrants than among natives, with an adjusted relative risk of 0.81/0.80 in Denmark and Finland, 0.62 in Norway, and 0.40 in Iceland. The lower attendance rates among immigrants in Norway and Iceland did not seem to be due to differences in birth country, immigration age, or educational level, but might be explained by organisational factors.Offering free-of-charge mammography screening in Norway and Iceland and/or including a pre-booked appointment in the invitation letters in Iceland might increase the attendance rate among non-Western immigrants.

Early effects of attendance to the Friuli Venezia Giulia (Northern Italy) mammography screening programme on the incidence of advanced-stage breast cancer: a cohort study

to evaluate the incidence of advanced-stage breast cancer (BC) - an early surrogate indicator of effectiveness of mammography screening - among women who attended the Friuli Venezia Giulia (FVG) Region (Northern Italy) screening programme compared to women who did not attend. retrospective cohort study. Women invited to the first screening round (2006-2007) were identified from the database of the programme. The cohort was record-linked to the archive of women invited to the second round (2008-2009). The definition of attendance to screening was based on attendance to at least one of the two rounds. The incidence of BC was assessed through record linkage with the FVG cancer registry using an anonymous univocal identifier (end of follow-up: 31st December 2013). Three distinct definitions of advanced stage were used: pT2 or greater (pT2+), positive lymph nodes (pN+), and TNM stage II or greater (stage II+). organized mammography screening programme for women aged 50-69 years in the five regional healthcare districts. incidence rate ratio (IRR) between attenders and non-attenders, adjusted for age and deprivation index, with 95% confidence interval (95%CI). the cohort included 104,488 attenders and 49,839 non-attenders. During follow-up (median duration 84 months), 2,717 invasive BCs were diagnosed among attenders and 1,149 among non-attenders. Total incidence rate was 13% higher among attenders (IRR 1.13; 95%CI 1.05-1.21). These, conversely, had a 36% lower rate of pT2+ BC (IRR 0.64; 95%CI 0.56-0.72), a 13% lower rate of pN+ BC (IRR 0.87; 95%CI 0.78-0.98), a 22% lower rate of stage II+ BC (IRR 0.78; 95%CI 0.70-0.87), and a 32% lower rate of mastectomy (IRR 0.68; 95%CI 0.60-0.78). attenders had lower incidence rates of advanced-stage BC. This early effect is suggestive of a future impact of the screening programme on BC mortality.

QIM19-119: Validity of the French-Language Mammography Satisfaction Instrument Evaluating Women’s Satisfaction With an Organized Breast Cancer Screening Program: A Confirmatory Study

Background: To evaluate the quality of an organized mammography screening program based on the perception of screened women, we developed and validated the French-language Mammography Satisfaction Instrument (MSI). The study objective was to confirm the validity and reliability of the MSI. Methods: A confirmatory study was conducted among 529 women who had had a recent screening mammography under the Quebec Breast Cancer Screening Program (PQDCS). Eligible women from the Quebec City region completed the online MSI between January 14 and May 23, 2016. The MSI originally included 14 items evaluating 4 factors: satisfaction with (1) the technician’s skills; (2) the physical environment; (3) the staff’s communication skills; and (4) the information provided under the program. A fifth factor with 2 items, evaluating mammography accessibility, was added. A confirmatory factor analysis (CFA) was done and goodness of fit indices were generated (SRMR, CFI, RMSEA with its 90% CI). Item reliability and composite reliability were estimated. Variance extract estimates (VEEs) were generated to assess the amount of variance explained by the factors. Multivariate logistic regressions were done to test the sensitivity of each scale to identify subgroups of unsatisfied women. Odds ratios (OR) and their 95% CI were estimated. Results: Most women (62.0%) were aged 55–64, and 32.9% had university level education. The CFA demonstrated that the 5 factors fitted the data well (SRMR=0.044; CFI=0.969; RMSEA=0.055 with its 90% CI: 0.047–0.063). Item reliabilities (≥0.55) and composite reliabilities (≥0.87) were high. All VEEs were also high (≥0.70). Pain during compression, anxiety before the mammography, perception of not having an excellent health, and the radiologic centers were the factors the most consistently and significantly associated with the 5 scales of satisfaction. In addition, women with university level education were less satisfied with the staff’s communication skills (OR=0.64; 95% CI: 0.43–0.97) and those having had less than 10 lifetime mammograms were less satisfied with the physical environment (OR=0.52; 95% CI: 0.33–0.83) and the accessibility (OR=0.53; 95% CI: 0.31–0.92). Conclusions: This confirmatory study showed the good reliability and validity of the construct of the 16-item MSI with 5 factors. The MSI is useful to detect unsatisfied women and to improve the quality of organized breast cancer screening programs.

Barriers to organized mammography screening program in Hungary: a questionnaire-based study of 3 313 women

Barriers to organized mammography screening program in Hungary: a questionnaire-based study of 3 313 women

Organised population-based programmes and change in socioeconomic inequalities in mammography screening: A 1992–2012 nationwide quasi-experimental study

Organised mammography screening programmes may reduce socioeconomic inequalities in breast cancer screening, but evidence is contradictory. Switzerland has no national organised mammography screening programme, but regional programmes were progressively introduced since 1999, giving the opportunity to conduct a nationwide quasi-experimental study. We examined the evolution of socioeconomic inequalities in mammography screening in Switzerland and if exposure to regional organised programmes reduced socioeconomic inequalities. Data of 10,927 women aged 50 to 70 years old were collected from the Swiss Health Interview Survey, a nationally representative cross-sectional survey repeated 5 times (1992–2012). Socioeconomic characteristics were assessed using education, income, employment status, and occupational class. Adjusted prevalence ratios of up-to-date mammography screening were estimated with Poisson regressions and weighted for sampling strategy and non-participation bias. In the absence of organised screening programmes (1992–1997), prevalence of mammography screening increased by 23% and was associated with tertiary education and working part time. During the period of progressive introduction of regionally organised programmes (2002−2012), prevalence of mammography screening increased by 19% every 5 years and was associated with exposure to regional programmes and with independent/artisan occupations. Tertiary education and working part time were no longer associated. Exposure to organised programmes did not modify socioeconomic inequalities except for employment status: not employed women benefitted more from organised programmes compared to women working full time. In conclusion, socioeconomic inequalities in mammography screening decreased over time but organised programmes did not greatly modify them, except women not employed whose prevalence passed employed women.

Clinical Image Quality and Sensitivity in an Organized Mammography Screening Program

PurposeThe study sought to examine the association between clinical image quality of mammograms and screening sensitivity. MethodsFour radiologists evaluated the clinical image quality of 374 invasive screen-detected cancers and 356 invasive interval breast cancers for which quality evaluation of screening mammograms could be assessed from cancers diagnosed among participants in the Quebec Breast Cancer Screening Program in 2007. Quality evaluation was based on the Canadian Association of Radiologists accreditation criteria, which are similar to those of the American College of Radiology. The association between clinical quality and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and adjusted sensitivity ratios were obtained through marginal standardization. No institutional review board approval was required. ResultsA proportion of 28% (206 of 730) of screening mammograms had lower overall quality for the majority of assessments. Positioning was the quality attribute that was the most frequently deficient. The 2-year screening sensitivity reached 68%. Sensitivity of screening was not statistically associated with the overall quality (ratio of 2-year sensitivity = 1.03; 95% confidence interval: 0.93-1.15) or with any quality attributes (positioning, exposure, compression, sharpness, artifacts, contrast). Results were similar for the 1-year sensitivity. ConclusionsAlthough not all mammograms in the Quebec screening program met the optimum quality required by the Canadian Association of Radiologists or American College of Radiology accreditation, the screening mammograms produced in this population-based organized screening program reached a high enough level of quality so that the remaining variation in quality is too little to impair screening sensitivity.

Mammography screening reduces breast cancer deaths in Ireland, study finds

Deaths from breast cancer were 9% lower in women living in a region of Ireland with a mammography screening programme compared with women of the same age living in a part of the country that introduced screening eight years later, a study comparing national data over this time period has found.1 “In order to weight the benefits against the potential harmful effects such as overdiagnosis, those who fund organised mammography screening programmes need to know how many future breast cancer deaths will be averted by them,” said the study authors, including James Hanley, from McGill University, Montreal, Canada, and Katie …

Cost-Effectiveness of Three Rounds of Mammography Breast Cancer Screening in Iranian Women.

BackgroundBreast cancer is the most common cancer in Iranian women as is worldwide. Mammography screening has been introduced as a beneficial method for reducing mortality and morbidity of this disease.ObjectivesWe developed an analytical model to assess the cost effectiveness of an organized mammography screening program in Iran for early detection of the breast cancer.Patients and MethodsThis study is an economic evaluation of mammography screening program among Iranian woman aged 40 - 70 years. A decision tree and Markov model were applied to estimate total quality adjusted life years (QALY) and lifetime costs.ResultsThe results revealed that the incremental cost effectiveness ratio (ICER) of mammography screening in Iranian women in the first round was Int. $ 37,350 per QALY gained. The model showed that the ICER in the second and third rounds of screening program were Int. $ 141,641 and Int. $ 389,148 respectively.ConclusionsStudy results identified that mammography screening program was cost-effective in 53% of the cases, but incremental cost per QALY in the second and third rounds of screening are much higher than the accepted payment threshold of Iranian health system. Thus, evaluation of other screening strategies would be useful to identify more cost-effective program. Future studies with new national data can improve the accuracy of our finding and provide better information for health policy makers for decision making.

Abstract P2-04-03: Can the interval cancer ratio diminish the need for background incidence estimates as a mammography screening programme performance indicator?

Abstract Background: Interval cancers (IC) are cancers that are discovered within the interval between two screening examinations, i.e. they present themselves clinically before the next scheduled screening examination. A mammography screening programme that is run in a population with a high breast cancer incidence can have a high interval cancer rate, and still have as protective an effect as a screening programme with a low IC-rate run in a population with a low breast cancer incidence. The effectiveness of a mammography screening programme is therefore normally evaluated by comparing the IC-rate to the expected breast cancer incidence without screening, i.e. the proportional interval cancer rate. The expected breast cancer incidence in absence of screening, or background incidence is, however, difficult to approximate, as the introduction of a screening program makes it difficult or impossible to find a comparable population group that is not screened. We propose to use a new measure, the number of interval cancers out of the total number of cancers, called the interval cancer ratio, as an alternative measure for the burden of interval cancers in an organized mammography screening programme. We seek to validate this new measure by comparing it to the old measure, the proportional interval cancer rate. Method: We did a systematic review and included studies: 1) covering a service screening programme, 2) with inclusion of women aged 50-69 years, 3) that contained observed data, papers based on modeling only were excluded, 4) that contained data on number of interval cancers and number of women screened, or on interval cancers rate, and 5) that contained information on estimated breast cancer incidence rate of the background population. This resulted in 6 papers describing 12 mammography screening programmes. Results: The IC- ratio in studies including only initial screens, varied from 0.13 to 0.32 while the proportional interval cancer rate varied from 0.24 to 0.55 in the same studies. In studies including only subsequent screens the IC-ratio varied from 0.21 to 0.47 with a proportional interval cancer rate of 0.26 to 0.67. One study with mixed initial and subsequent screens with a majority of initial screens had an IC-ratio of 0.18, whereas the proportional interval cancer rate was 0.33. In the study with a majority of subsequent screens had an IC-ratio was 0.32 and the proportional interval cancer rate was 0.67. There is a strong linear relationship between the interval cancer ratio and the proportional interval cancer rate in initial screens. In subsequent screens the trend is linear but is less obvious. Conclusion: Our main aim with this study was to propose and validate the interval cancer ratio as an alternative measure for the burden of interval cancers. The new measure seems to capture the burden of interval cancers just as well or better than the old measure, without the need for increasingly difficult estimations of background incidence, which makes it a more accessible tool when evaluating mammography screening programme performance. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-04-03.

Abstract P2-04-06: Successful results of a population-based organized mammography screening program in a developing country: The Turkish experience

Abstract Objective: This study aims to determine the feasibility of a population-based organized mammography screening in a developing country (Bahcesehir, Istanbul, Turkey) and to find out the starting age for screening. Material and methods: Women aged 40–69 were invited for screening at 2-year intervals starting in January 2009. Digital 2-view mammograms were obtained, and mammograms were double read by two independent radiologists who were experienced in breast imaging. The women were recalled in consensus for additional work-up including spot compression/magnification mammograms or breast ultrasound. Outcomes were measured from final assessment or histopathologic confirmation. The participation rate for second round, recall rate, number of biopsies, the women diagnosed with cancer and patient and tumor characteristics were evaluated. Results: Between January 2009 and January 2013, 5938 (89.4%) of 6640 women aged between 40-69 years old accepted mammographic invitation. Most of them (58%) were at 40-49 age group, and the average 2-year attendance for second rounds were 82.6% and 81.2%, respectively. Spot recall rates were 16.8% and 25.6% for the first and second rounds, respectively. Core biopsy was required in 108 patients (1.8%), whereas BC was diagnosed in 50 patients (0.84%). Twenty-four patients (48%) detected with BC were at 40-49 age group. There were 39 patients (78%) with invasive BC and 11 patients (22%) with ductal carcinoma in situ (DCIS). Stages of 39 patients with invasive BC were Stage I (n = 26; 52%), II (n = 10; 20%) and III (n = 3; 6%), respectively. The majority of patients (88%) had breast conserving surgery, and sentinel lymph node biopsy only (72%) as axillary procedure. Of invasive cancers, 92% were found to be hormone receptor positive, and 59% had low Ki67 levels (≤15). However, HER2-neu positivity (8%) along with triple negative cancers (3%) were less frequently detected. Conclusion: These findings suggest the prevailing view that mammographic screening increases early breast cancer detection rate which has a less aggressive biology. Screening mammography program can be successfully implemented in a developing country, Turkey effectively. However, more experienced dedicated breast cancer screening team and continuous increasing efforts are required to decrease our relatively high recall rates. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-04-06.

Gründe für die Nicht-Teilnahme am Mammographie-Screening - eine Querschnittsuntersuchung aus Schleswig-Holstein

In 2007, an organized population-based mammography screening program in Schleswig-Holstein has been implemented. According the European guideline a participation rate of 70% should be reached as a measurement of quality. In Schleswig-Holstein participation rate reached only 45% and is one of the lowest rates in Germany. The reasons are unknown. To 20,000 women, aged 50-69, who did not participate in mammography screening after an invitation letter, a questionnaire was sent to assess reasons of non-participation and knowledge about the program. We calculated the proportion of women answering to given aspects in the questionnaire. The response rate was 14.8% (n = 2591). Women reported multiple reasons for non-participation. Medical reasons and personal attitude were the most frequent ones. Organizational reasons were of minor importance. 75% of women get primarily informed about the program by the invitation letter. 25% of women talked with their practitioner about the program. The low participation rate of mammography screening in Schleswig-Holstein is not based on worse organization but on medical reasons or personal attitudes of the women. It seems, that information about the program and benefits and harms of mammography screening has not reached the general population. So general practitioner or gynecologists should advice women more intensively. Leaflets and pamphlets should be more disseminated.

PCN27 - Racial Disparities in Diffusion, Comparative Morbidity, and Disease Control of Intensity-Modulated Radiation Therapy Compared to Conformal Radiation Therapy for Localized Prostate Cancer

benign and malignant cases. Results: In 2008-2009 there were 477904 screening mammography examinations in Hungary. 5.15 % of participating women were recalled. The attendance of re-called women was 92.25 %. Altogether 2092 women (9.7 %) were referred for breast surgery but only 1485 women (71.0 %) underwent surgery. Histological examination confirmed 281 benign (18.9 %) and 1204 malignant (81.1 %) cases. ConClusions: The quality indicators of the Hungarian organized mammography screening program met the recommendations of international professional guidelines. However, in addition to current indicators, new ones should be introduced in order to provide a more comprehensive monitoring of the program.

Does breast cancer screening level health inequalities out? A population-based study in an Italian region

Although population-based screening has the potential to reduce inequalities in breast cancer survival, evidence on this topic is controversial. The objective of this study was to evaluate whether the full implementation of a mammography screening programme in Emilia-Romagna in Italy had an impact on variations in breast cancer survival by educational level. A cohort study was performed, including all women <70 years and residing in Emilia-Romagna who had infiltrating breast cancer registered in 1997-2000 (transitional screening period) or 2001-03 (consolidation screening period). Cancer cases were retrieved from the regional Breast Cancer Registry and followed up for 5 years. Educational level was determined from census data and allocated to cancer cases by individual record linkage. Age at diagnosis was classified into two groups (30-49, 50-69: screening target population). A total of 9639 cases were analyzed. In the 1997-2000 period, low-educated women had significantly lower survival compared with high-educated women, both in the younger and in the older age-groups. After the full implementation of the screening programme, these differences decreased in both age-groups, until disappearing completely among women in the age-group invited to screening. Our findings suggest that a fee-free population-based organized mammography screening programme with active invitation of the whole target population could be effective in reducing differences in survival in the population targeted by the screening.

Contribution and Performance of Mobile Units in an Organized Mammography Screening Program

The aims of this study were to evaluate the contribution of mobile mammography units to participation rate and to compare their performance to fixed screening centres within the organized mammography screening program of Quebec, Canada. The study is based on all screening mammograms carried out in women aged 50-69 who participated in the Québec program from 2002 to 2010. Performance was measured by screening sensitivity, false-positive rate (1-specificity), positive likelihood ratio as well as abnormal call rate, detection rate, interval cancer rate, positive predictive value, and tumour characteristics. Poisson regression models with robust variance estimation were used to take into account the multi-level structure of the data. All models were adjusted for characteristics related to women. During the 2002-2010 period, 2,292,592 screening mammograms were performed, of which 42,279 (1.8%) were in mobile units. In regions serviced exclusively by mobile units, the participation rate reached an average of 63.4% during the 2006-2010 period compared to 54.7% for the entire study population. Estimated sensitivity was similar to that of fixed sites (rate ratio = 0.98 [0.84-1.15]) while the false-positive rate was lower (rate ratio = 0.76 [0.57-1.02]) although this difference was of marginal statistical significance (p=0.07). In this program, mobile mammography units allowed regions lacking a fixed centre to attain participation rates slightly higher than those in the rest of Quebec, without loss of sensitivity and with some gain in the false-positive rate.

Breast cancer mortality in Norway after the introduction of mammography screening

An organized mammography screening program was gradually implemented in Norway during the period 1996-2004. Norwegian authorities have initiated an evaluation of the program. Our study focused on breast cancer mortality. Using Poisson regression, we compared the change in breast cancer mortality from before to during screening in four counties starting the program early controlling for change in breast cancer mortality during the same time in counties starting the program late. A follow-up model included death in all breast cancers diagnosed during the follow-up period. An evaluation model included only breast cancers diagnosed in ages where screening was offered. The study group had been invited for screening one to three times and followed for on average of 5.9 years. In the follow-up model, 314 breast cancer deaths were observed in the study group, and 523, 404 and 638, respectively, in the four control groups. The ratio between the changes in breast cancer mortality between early and late starting counties was 0.93 (95% confidence interval [CI] 0.77-1.12). In the evaluation model, this ratio was 0.89 (95% CI: 0.71-1.12). In Norway, where 40% of women used regular mammography prior to the program, the implementation of the organized mammography screening program was associated with a statistically nonsignificant decrease in breast cancer mortality of around 11%.

Should breast cancer survivors be excluded from, or invited to, organised mammography screening programmes?

BackgroundThe prevalence of breast cancer in developed countries has steadily risen over recent decades. Immediate and long-term health needs of patients, including preventive care and screening services, are receiving increasing attention. A question still unresolved is whether breast cancer survivors should receive mammographic surveillance in the clinical or screening setting and, thus, whether they should be excluded from, or invited to, organised mammography screening programmes. The objective of this article is to discuss the many contradictory aspects of this matter.DiscussionProblems with mammographic surveillance of breast cancer survivors include: weak evidence of a reduction in mortality; lack of evidence in favour of one setting or the other; lack of evidence-based guidelines for the frequency and duration of surveillance; disproportionate emphasis placed on the first few years post-treatment, probably dictated by surgical and oncological priorities; a variety of screening policies, as these women are permanently or temporarily or partially excluded from many - but not all - organised screening programmes worldwide; an even greater disparity in follow-up protocols used in the clinical setting; a paucity of data on compliance to mammographic surveillance in both settings; and a difficulty in coordinating the roles of health care providers. In the future, the use of mammography in breast cancer survivors will be influenced by the inclusion of women aged > 69 years in organised screening programmes and the implementation of multidisciplinary breast units, and will probably be investigated by research activities on individual risk assessment and risk-tailored screening. In the interim, current problems can be partially alleviated with some technical solutions in screening data recording, patient flows, and care coordination.SummaryMammographic surveillance of breast cancer survivors is situated at the crossroads of numerous different specialist areas of breast cancer control and management. The solutions for current problems probably lie in some important modifications in the conventional screening procedure that are underway or under study. These developments appear to be directed towards a partial modification of the screening rationale, with an adaptation to meet the diversified breast care needs of women. The complexity of the matter constitutes a call to action for several entities to eliminate the barriers to effective research in this field.

Overuse of mammography during the first round of an organized breast cancer screening programme

We examined the frequency of mammography screening among women who had had a screening mammogram recently and therefore generally did not need to repeat the examination. A population-based sample of 50- to 69-year-old women were surveyed immediately before and 8 months after they received an invitation to participate in the first round of screening of the newly organized mammography screening programme in Geneva, Switzerland. These women also received a booklet that included the recommendation to have screening mammograms at 2-year intervals. The baseline survey identified 660 women who had had a mammogram within the previous 12 months. Of these, 23.2% [95% confidence interval (CI), 20.0-26.6] had an opportunistic mammogram and 4.1% (95% CI, 2.7-5.9) had an organized mammogram during follow-up. Women who had had their last mammogram 6-12 months prior to baseline (vs. more recently), intended to have a mammogram within the next 6 months, wished to receive more information on mammography screening, and had a history of surgical breast biopsy were more likely to have an unnecessary screening mammogram (either organized or opportunistic) during follow-up. Compared with women who had an opportunistic mammogram, women who had an organized mammogram were more likely to be of lower socioeconomic status, to have made their own screening decision and to have anticipated the date of their next mammogram by no more than a few months. Opportunistic mammography screening in excess of recommendation is common, and persists despite explicit advice about recommended screening frequency.

Improved breast cancer survival following introduction of an organized mammography screening program among both screened and unscreened women: a population-based cohort study

IntroductionMammography screening reduces breast cancer mortality through earlier diagnosis but may convey further benefit if screening is associated with optimized treatment through multidisciplinary medical care. In Norway, a national mammography screening program was introduced among women aged 50 to 69 years during 1995/6 to 2004. Also during this time, multidisciplinary breast cancer care units were implemented.MethodsWe constructed three cohorts of breast cancer patients: 1) the pre-program group comprising women diagnosed and treated before mammography screening began in their county of residence, 2) the post-program group comprising women diagnosed and treated through multidisciplinary breast cancer care units in their county but before they had been invited to mammography screening; and 3) the screening group comprising women diagnosed and treated after invitation to screening. We calculated Kaplan-Meier plots and multivariable Cox proportional hazard models.ResultsWe studied 41,833 women with breast cancer. The nine-year breast cancer-specific survival rate was 0.66 (95%CI: 0.65 to 0.67) in the pre-program group; 0.72 (95%CI: 0.70 to 0.74) in the post-program group; and 0.84 (95%CI: 0.80 to 0.88) in the screening group. In multivariable analyses, the risk of death from breast cancer was 14% lower in the post-program group than in the pre-program group (hazard ratio 0.86; (95%CI: 0.78 to 0.95, P = 0.003)).ConclusionsAfter nine years follow-up, at least 33% of the improved survival is attributable to improved breast cancer management through multidisciplinary medical care.

Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends

Objective To estimate the extent of overdiagnosis (the detection of cancers that will not cause death or symptoms) in publicly organised screening programmes.Design Systematic review of published trends in incidence...

Workflow in der digitalen Screeningmammographie

The overriding goal of an organized mammography screening program is to offer high level medical care to everyone at a justifiable cost. The following overview will demonstrate how both aspects of screening, quality and cost efficiency, are supported by a fully digital workflow. Digital mammography systems allow for a constant high image quality and repeat examinations due to overexposure or underexposure can be avoided. Dedicated mammography screening workstations with integration of image viewing and reporting enable efficient softcopy reading. Many aspects of the screening workflow, such as double reading, archiving and retrieval of stored films, as well as information exchange between members of the certified team of the screening unit and other physicians involved in the further treatment, are made significantly easier by the presence of image data in digital form.